What is the difference between falling ill suddenly and seeking treatment?

You are on holiday in Spain and get a severe sore throat and need to go to the health centre to see a doctor. You have a European Health Insurance Card with you and you pay the local client fee for the treatment yourself. When you return home, you see an advertisement for an Estonian dental clinic and wonder whether you could combine a visit to the dentist with your upcoming holiday in Tallinn. You make an appointment with the clinic and go for a dental examination in Tallinn. The treatment is not covered by the European Health Insurance Card, but you can claim reimbursement retrospectively from Kela.

One of these is considered a case of sudden illness, the other seeking treatment. But how do you know which one it is?

Sudden situation or planned treatment?

In short, a sudden illness is usually an unexpected need to use healthcare services abroad. We could be talking about a sudden ear infection or an ankle sprained in an accident, for example. What these situations have in common is that you are staying abroad temporarily and for a reason other than to access healthcare services – for example, for a holiday, business trip or exchange studies. If you need treatment for a chronic condition or pregnancy in the middle of your stay abroad, this also counts as a sudden illness.

Seeking treatment, on the other hand, means that you purposefully and specifically travel abroad to receive treatment. It can also be combined with a holiday or a visit to a relative’s, for example, but the treatment itself and the need for it do not arise unexpectedly while abroad.

Please note that you can only be reimbursed for treatment in the EU and EEA countries, the United Kingdom and Switzerland for both a sudden illness and when seeking treatment. Elsewhere, you will be responsible for all costs yourself, unless you have private insurance to cover them.

Proceed as follows if you need treatment abroad

If you fall ill while travelling, you can go to a hospital or doctor’s surgery and show your European Health Insurance Card. With the card, you can get the treatment you need while you are temporarily abroad. You will pay the local client fee for the treatment. You can order a European Health Insurance Card free of charge from Kela.

In general, the European Health Insurance Card is valid in public healthcare and in treatment places that have an agreement with the local health insurance fund. A doctor or nurse will assess the type of treatment you should receive. With the European Health Insurance Card, you should receive treatment that cannot wait for your planned return to Finland. If, for some reason, you have to pay the costs yourself, you can claim reimbursement retrospectively from Kela.

How to purposely seek treatment

You can purposely seek medical treatment in another country within the EU. In this case, you cannot use the European Health Insurance Card.

You must agree on the treatment arrangements with the clinic or hospital in advance, pay the costs yourself and claim reimbursement retrospectively from Kela. A prerequisite for reimbursement is that the treatment is included in the range of public healthcare services in Finland and that you would have received similar treatment in your own wellbeing services county. You must also have a referral, if such would also have been required in Finland.

You can also seek treatment with a prior authorisation granted by Kela pursuant to the relevant EU regulation (form S2). If you receive a prior authorisation, you will only need to pay the local client fee. The prior authorisation can generally be used in public treatment places and places that have an agreement with the public healthcare system.

What if I want to receive treatment outside the EU?

You can only use the European Health Insurance Card, apply for a prior authorisation and receive reimbursement from Kela for planned medical treatment if you receive treatment in an EU or EEA country, Switzerland or the United Kingdom. In certain cases, you may also be able to get treatment in Australia and Quebec, Canada.

Of course, you are also allowed to travel outside the EU for treatment. Please note, however, that you will not be able to get help with the costs from Kela. If you are about to travel outside the EU, it is particularly important to take out comprehensive travel insurance.